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Emergency Evaluation and Treatment

Assess for Hemodynamic Instability

Hypotension

If blood pressure and pulse are normal in the supine position, measure them in the sitting position. If they are still normal, measure them in the standing position to detect more subtle volume depletion. Supine or postural hypotension can indicate life-threatening hemorrhage.

Determine the amount of blood loss and draw blood for (a) typing and crossmatching (reserve four units of fresh-frozen plasma and two to four units of packed red cells), (b) platelet count, prothrombin time, and partial thromboplastin time to uncover any bleeding abnormality, (c) complete blood count (CBC), (d) renal function tests and measurement of serum electrolytes, and (e) blood gas measurements and pH (useful in assessing adequacy of ventilation and perfusion).

Insert a Foley catheter.

If the patient is of child-bearing age, obtain a serum or urinary pregnancy test.